Left Ventricular Geometry and Renal Function in Hypertensive Patients With Diastolic Heart Failure Farsad Afshinnia, MD, Samuel Spitalewitz, MD, Shyan-Yih Chou, MD, FACP, David Z. Gunsburg, MD, FACC, and Hal L. Chadow, MD, FACC Background: The objective is to define the relationship between cardiac geometry and renal function in hypertensive subjects with and without diastolic heart failure (DHF). Methods: This is a prospective observational study in a tertiary-care teaching institute in a 15-month period of consecutive hospitalized hypertensive patients. Patients on dialysis therapy or with atrial fibrillation, systolic heart failure, gross proteinuria, and glomerular diseases were excluded. Two-dimensional echocar- diography was performed and stable glomerular filtration rate (GFR) was calculated by using the Modifica- tion of Diet in Renal Disease formula. Patients were classified into stage 1 to 5 chronic kidney disease (CKD). Results: Five hundred forty hypertensive patients were separated into 2 groups: 286 patients with DHF and 254 patients without DHF. Mean age was 69.1  13.7 (SD) years in general. In patients with DHF, from stages 1 to 5 CKD, there was a significant graded increase in left ventricular mass index (from 117.3 to 162.4 g/m 2 ) and relative wall thickness (from 0.42 to 0.52) and a significant graded decrease in aortic cusp separation (from 1.85 to 1.55 cm). Among echocardiographic variables, left ventricular mass index and relative wall thickness were associated inversely and aortic cusp separation was associated directly with GFR. In the absence of DHF, only left ventricular mass index was associated inversely with GFR, suggesting a prominent role of aortic cusp separation and relative wall thickness in the variability in GFR in patients with DHF through a hemodynamic disturbance. Conclusion: Hemodynamic alterations have a prominent role in the variability of GFR in patients with CKD with DHF. Adverse cardiac geometry is linked to the severity of CKD in hypertensive patients, raising the possibility of preserving both cardiac and renal function by means of hypertension control. Am J Kidney Dis 49:227-236. © 2007 by the National Kidney Foundation, Inc. INDEX WORDS: Chronic kidney disease; cardiac morphology; hypertensive nephrosclerosis; diastolic heart failure. T he Third National Health and Nutrition Ex- amination Survey indicated that almost 29% of the adult US population, an estimated 58.4 million individuals, had hypertension in 1999 to 2000, a 3.7% increase from 1988 to 1991. 1 Congestive heart failure (CHF) is a signifi- cant cardiovascular complication of hyperten- sion. 2 There are about 1 million hospitalizations and 50,000 deaths caused by CHF each year in the United States. 3 Up to 30% to 50% of patients with CHF have isolated diastolic heart failure (DHF). 4-7 Preliminary data from the Framing- ham Study showed that hypertension was the most common underlying cardiovascular disease in patients with isolated DHF. 6 There also are more than 19 million individu- als in the United States with kidney impairments, of whom nearly 8 million persons have chronic kidney disease (CKD), defined as a glomerular filtration rate (GFR) less than 60 mL/min/1.73 m 2 (1.00 mL/s). 8 Currently, more than 400,000 pa- tients have end-stage renal disease in the United States. 9 Hypertensive nephrosclerosis is respon- sible for up to 25% of end-stage renal disease. 10 According to the US Renal Data System, more than 450,000 Medicare patients with CKD also have CHF. 9 Hypertension as a common etiologic From the Department of Internal Medicine at Memorial Medical Center, Sutter-Gould Medical Foundation Inc, Modesto, CA; Department of Internal Medicine, Division of Nephrology and Hypertension; Division of Cardiology; and Non-Invasive Cardiology, Brookdale University Hospital and Medical Center; SUNY Downstate Health Science Cen- ter, Brooklyn, NY. Received July 7, 2006; accepted in revised form October 20, 2006. Originally published online as doi:10.1053/j.ajkd.2006.10.021 on December 28, 2006. Support: None. Potential conflicts of interest: None. Institution where the work has been done: Brookdale University Hospital and Medical Center, Brooklyn, NY. Pre- sented in abstract form as a poster at the 38th Annual Meeting of the American Society of Nephrology, Philadel- phia, PA, November 8-13, 2005. Address reprint requests to Farsad Afshinnia, MD, 1700 Coffee Rd, Memorial Medical Center, Modesto, CA 95355. E-mail: afshinnia@hotmail.com © 2007 by the National Kidney Foundation, Inc. 0272-6386/07/4902-0008$32.00/0 doi:10.1053/j.ajkd.2006.10.021 American Journal of Kidney Diseases, Vol 49, No 2 (February), 2007: pp 227-236 227